The Death of Bilal al-Sudani and Its Impact on Islamic State Operations

IN LATE JANUARY, the U.S. military conducted an operation in a cave complex located in northern Somalia that resulted in the death of Bilal al-Sudani, a key operative and facilitator for the Islamic State. The raid provides further evidence that Africa has become the “epicenter” for Islamic State activity in particular and for the global Sunni jihadist movement more broadly. Certainly, counterterrorism has been downgraded as a U.S. national security priority. Yet, the use of American military personnel in a risky ground-based operation reflects al-Sudani’s importance as well as the Unite

Supporting Students after a Concussion: School Administrators’ Perspectives

Students with a concussion may experience challenges when returning to school and completing schoolwork. Therefore, students may require temporary academic support throughout the recovery process. The purpose of this study was to examine school administrators’ perceptions of the return to school process and provision of academic adjustments (AA) after concussion. Online surveys were analyzed using a series of descriptive, chi-square, and Mann Whitney tests. School administrators strongly agreed a concussion can affect school performance and were supportive of providing AA for symptomatic students. More school administrators with access to an athletic trainer and who completed concussion training had an established team to monitor concussions and reported students had received AA after concussion. To better prepare school professionals and enhance the support for students after a concussion, school administrators can develop a school-based concussion team, organize in-service training on concussion, and identify pertinent school and district-based resources to facilitate this care

Carrots, Sticks, and Insurgent Targeting of Civilians

How do conciliatory and coercive counterinsurgency tactics affect militant group violence against civilians? Scholars of civil war increasingly seek to understand intentional civilian targeting, often referred to as terrorism. Extant research emphasizes group weakness, or general state attributes such as regime type. We focus on terrorism as violent communication and as a response to government actions. State tactics toward groups, carrots and sticks, should be important for explaining insurgent terror. We test the argument using new data on terrorism by insurgent groups, with many time-varying variables, covering 1998 through 2012. Results suggest government coercion against a group is associated with subsequent terrorism by that group. However, this is only the case for larger insurgent groups, which raises questions about the notion of terrorism as a weapon of the weak. Carrots are often negatively related to group terrorism. Other factors associated with insurgent terrorism include holding territory, ethnic motivation, and social service provision

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Replication Data for: Foreign Fighters and Lethality in Civil Conflicts

Dataset represents a synthesis of David Malet's Foreign Fighter Data (2007 version), the UCDP Battle-Related Deaths Dataset (Version 5, 2015), the Quality of Government Standard Dataset (version Jan15), and original research. See accompanying paper for further citation information

Athletic Trainers’ Perceptions of and Barriers to Patient Care Documentation: A Report From the Athletic Training Practice-Based Research Network

Context:  For the practice characteristics of the services athletic trainers (ATs) provide to be identified, all ATs must complete high-quality patient care documentation. However, little is known about ATs\u27 perceptions of patient care documentation or the potential barriers they may encounter while trying to ensure high-quality documentation. Objective:  To explore ATs\u27 perceptions of and barriers to patient care documentation via the Clinical Outcomes Research Education for Athletic Trainers electronic medical record system in the secondary school setting. Design:  Qualitative study. Setting:  Individual telephone interviews. Patients or Other Participants:  We interviewed 10 ATs (4 men, 6 women; age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) who were members of the Athletic Training Practice-Based Research Network (AT-PBRN) and employed in the secondary school setting. Data Collection and Analysis:  We conducted an individual interview with each participant. After transcription of the interviews, the data were analyzed into common themes and categories following the consensual qualitative research tradition. Data triangulation occurred through member checking and multiple researchers to ensure accuracy during data analysis. Results:  Participants revealed several perceptions of patient care documentation, consisting of quality, expectations and accountability, priority, incentive, and culture of the secondary school setting. In addition, we identified barriers to quality patient care documentation: lack of time, lack of accountability for documenting patient care, inadequate facility resources, and lack of additional personnel. Participants discussed the volume of patients as a unique challenge in the secondary school setting. Conclusions:  Whereas ATs perceived patient care documentation as important, several practical barriers may inhibit their ability to complete high-quality documentation of the services they provide. Effective strategies to improve the quality of patient care documentation among ATs are needed to ensure that their value, particularly in the secondary school setting, is accurately characterized

Athletic Trainers\u27 Reasons for and Mechanics of Documenting Patient Care: A Report From the Athletic Training Practice-Based Research Network

Context:  Documenting patient care is an important responsibility of athletic trainers (ATs). However, little is known about ATs\u27 reasons for documenting patient care and mechanics of completing documentation tasks. Objective:  To understand ATs\u27 perceptions about reasons for and the mechanics of patient care documentation. Design:  Qualitative study. Setting:  Individual telephone interviews with Athletic Training Practice-Based Research Network members. Patients or Other Participants:  Ten ATs employed in the secondary school setting (age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) were recruited using a criterion-based sampling technique. Participants were Athletic Training Practice-Based Research Network members who used the Clinical Outcomes Research Education for Athletic Trainers electronic medical record system and practiced in 6 states. Data Collection and Analysis:  We used the consensual qualitative research tradition. One investigator conducted individual telephone interviews with each participant. Data collection was considered complete after the research team determined that data saturation was reached. Interviews were transcribed verbatim and independently analyzed by 4 research team members following the process of open, axial, and selective coding. After independently categorizing interview responses into categories and themes, the members of the research team developed a consensus codebook, reanalyzed all interviews, and came to a final agreement on the findings. Trustworthiness was established through multiple-analyst triangulation and member checking. Results:  Participants identified 3 reasons for documenting patient care: communication, monitoring patient care, and legal implications. Four subcategories emerged from the mechanics-of-documentation theme: location, time of day, length of time, and criteria for documenting. The ATs described different criteria for documenting patient care, ranging from documenting every injury in the same manner to documenting time-loss and follow-up injuries differently. Conclusions:  Whereas ATs recognized individual mechanisms that enabled them to document patient care, they may need more guidance on the appropriate criteria for documenting various patient care encounters and strategies to help them document more effectively